In 2017, First Candle launched Straight Talk for Infant Safe Sleep to address the implicit bias that impacts how families learn about the safe sleep recommendations and can adopt them into their lives. It is a train-the-trainer program for trusted community partners including nurses, OB/GYNs, doulas, social service agencies, childcare providers and faith-based leaders. The curriculum reviews the American Academy of Pediatrics’ safe sleep guidelines, the reasons behind them and explores the social determinants and cultural beliefs unique to each community. The focus of the program is recognizing and addressing personal bias and improving communication skills to effectively engage with families. An overview of our program can be found here.

For Families: Safe
Sleep Recommendations

Every year 3,600 babies die from sleep-related infant deaths
including Sudden Infant Death Syndrome and accidental suffocation. In 79% of these
cases, babies were either sleeping in an adult bed or in their crib/bassinet
with pillows, blankets, stuffed animals, fluffy bumpers or loose clothing.
These deaths are preventable and, by following the safe sleep recommendations
developed by the American Academy of Pediatrics in 2016, we can dramatically
reduce this number.

Here’s what every family needs to know to reduce the risk of
SIDS and prevent accidental suffocation:

SAFE SLEEP RECOMMENDATIONS

Back to sleep for every sleep.

To reduce the risk of SIDS, infants should be placed for sleep
in a supine position (wholly on the back) for every sleep by every caregiver
until the child reaches 1 year of age. Side sleeping is not safe and is
not advised.

Use a firm sleep surface.

Infants should be placed on a firm sleep surface (eg,
mattress in a safety-approved crib) covered by a fitted sheet with no other
bedding or soft objects to reduce the risk of SIDS and suffocation.

A firm surface maintains its shape and will not indent or
conform to the shape of the infant’s head when the infant is placed on the
surface. Soft mattresses, including those made from memory foam, could create a
pocket (or indentation) and increase the chance of rebreathing or suffocation
if the infant is placed in or rolls over to the prone position.

Soft materials or objects, such as pillows, quilts,
comforters, or sheepskins, even if covered by a sheet, should not be placed
under a sleeping infant. If a mattress cover to protect against wetness is
used, it should be tightly fitting and thin.

The infant should sleep in an area free of hazards, such as
dangling cords, electric wires, and window-covering cords, because these may
present a strangulation risk.

Sitting devices, such as car seats, strollers, swings,
infant carriers, and infant slings, are not recommended for routine sleep in
the hospital or at home, particularly for young infants.

Infants who are younger than 4 months are particularly at
risk, because they may assume positions that can create a risk of suffocation
or airway obstruction or may not be able to move out of a potentially
asphyxiating situation. When infant slings and cloth carriers are used for
carrying, it is important to ensure that the infant’s head is up and above the
fabric, the face is visible, and the nose and mouth are clear of obstructions. After
nursing, the infant should be repositioned in the sling so that the head is up,
is clear of fabric, and is not against the adult’s body or the sling. If an
infant falls asleep in a sitting device, he or she should be removed from the
product and moved to a crib or other appropriate flat surface as soon as is
safe and practical. Car seats and similar products are not stable on a crib
mattress or other elevated surfaces.

Breastfeeding is recommended.

Breastfeeding is associated with a reduced risk of SIDS. Unless
contraindicated, mothers should breastfeed exclusively or feed with expressed
milk (ie, not offer any formula or other nonhuman milk-based supplements) for 6
months, in alignment with recommendations of the AAP.

The protective effect of breastfeeding increases with
exclusivity. However, any breastfeeding has been shown to be more protective
against SIDS than no breastfeeding.

It is recommended that infants sleep in the parents’
room, close to the parents’ bed, but on a separate surface designed for
infants, ideally for the first year of life, but at least for the first 6
months.

There is evidence that sleeping in the parents’ room but on
a separate surface decreases the risk of SIDS by as much as 50%. In
addition, this arrangement is most likely to prevent suffocation,
strangulation, and entrapment that may occur when the infant is sleeping in the
adult bed.

Placing the crib close to the parents’ bed so that the
infant is within view and reach can facilitate feeding, comforting, and
monitoring of the infant. Room-sharing reduces SIDS risk and removes the
possibility of suffocation, strangulation, and entrapment that may occur when
the infant is sleeping in the adult bed.

Couches and armchairs are extremely dangerous places for
infants. Sleeping on couches and armchairs places infants at extraordinarily
high risk of infant death, including SIDS suffocation through entrapment or
wedging between seat cushions, or overlay if another person is also sharing
this surface. Therefore, parents and other caregivers should be especially
vigilant as to their wakefulness when feeding infants or lying with infants on
these surfaces. Infants should never be placed on a couch or armchair for
sleep.

Keep soft objects and loose bedding away from the
infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and
strangulation.

Soft objects, such as pillows and pillow-like toys,
quilts, comforters, sheepskins, and loose bedding, such as blankets and
nonfitted sheets, can obstruct an infant’s nose and mouth. An obstructed airway
can pose a risk of suffocation, entrapment, or SIDS.

Infant sleep clothing, such as a wearable blanket, is
preferable to blankets and other coverings to keep the infant warm while
reducing the chance of head covering or entrapment that could result from
blanket use.

Consider offering a pacifier at nap time and bedtime.

Although the mechanism is yet unclear, studies have reported
a protective effect of pacifiers on the incidence of SIDS. The protective
effect of the pacifier is observed even if the pacifier falls out of the
infant’s mouth.

The pacifier should be used when placing the infant for
sleep. It does not need to be reinserted once the infant falls asleep. If the
infant refuses the pacifier, he or she should not be forced to take it. In
those cases, parents can try to offer the pacifier again when the infant is a
little older.

Because of the risk of strangulation, pacifiers should not
be hung around the infant’s neck. Pacifiers that attach to infant clothing
should not be used with sleeping infants.

Objects, such as stuffed toys and other items that may
present a suffocation or choking risk, should not be attached to pacifiers.

For breastfed infants, pacifier introduction should be
delayed until breastfeeding is firmly established. Infants who are not
being directly breastfed can begin pacifier use as soon as desired.

There is insufficient evidence that finger sucking is
protective against SIDS.

Avoid smoke exposure during pregnancy and after birth.

Both maternal smoking during pregnancy and smoke in the
infant’s environment after birth are major risk factors for SIDS.

Mothers should not smoke during pregnancy or after the
infant’s birth.

There should be no smoking near pregnant women or infants.
Encourage families to set strict rules for smoke-free homes and cars and to
eliminate secondhand tobacco smoke from all places in which children and other
nonsmokers spend time.

The risk of SIDS is particularly high when the infant
bed-shares with an adult smoker, even when the adult does not smoke in bed.

Avoid alcohol and illicit drug use during pregnancy and
after birth.

There is an increased risk of SIDS with prenatal and
postnatal exposure to alcohol or illicit drug use.

Mothers should avoid alcohol and illicit drugs periconceptionally
and during pregnancy.

Parental alcohol and/or illicit drug use in combination with
bed-sharing places the infant at particularly high risk of SIDS.

Avoid overheating and head covering in infants.

Although studies have shown an increased risk of SIDS with
overheating,the definition of overheating in these studies varies. Therefore,
it is difficult to provide specific room temperature guidelines to avoid
overheating.

In general, infants should be dressed appropriately for the
environment, with no greater than 1 layer more than an adult would wear to be
comfortable in that environment.

Parents and caregivers should evaluate the infant for signs
of overheating, such as sweating or the infant’s chest feeling hot to the
touch.

Overbundling and covering of the face and head should be
avoided.

There is currently insufficient evidence to recommend the
use of a fan as a SIDS risk-reduction strategy.

Infants should be immunized in accordance with
recommendations of the AAP and Centers for Disease Control and Prevention.

There is no evidence that there is a causal relationship
between immunizations and SIDS. Indeed, recent evidence suggests that
vaccination may have a protective effect against SIDS.

Avoid the use of commercial devices that are inconsistent
with safe sleep recommendations.

Be particularly wary of devices that claim to reduce the
risk of SIDS. Examples include, but are not limited to, wedges and positioners
and other devices placed in the adult bed for the purpose of positioning or
separating the infant from others in the bed.

Supervised, awake tummy time is recommended to facilitate
development and to minimize development of positional plagiocephaly.